<form action="https://www.scnet.com.au/ipayby/hostedccbuy" method="post"> 
<div><label class="left" for="Name">Name</label>
<div><input id="Name" maxlength="32" name="cust" size="30" type="text" /></div></div> 
<div><label class="left" for="Email">Email address</label> 
<div><input id="Email" name="emailcapture" type="text" /></div> 
<div><label>Select your donation amount</label>  
<select id="Donation" name="amount">   
<option value="10.00">$10</option>  
<option value="50.00">$50</option></select> 
<input name="shop" type="hidden" value="Dogs' Refuge Online Donations" />  
<input name="message" type="hidden" value="Thanks again for thinking of us!" />  
<input name="image" type="hidden" value="drh-form-header.gif" />  
<input name="tablebgcolour" type="hidden" value="839912" /> 
<input name="info" type="hidden" value="DONATION" />  
<input name="requiredfields" type="hidden" value="emailcapture" />  
<input name="adminemail" type="hidden" value="enquiries@dogshome.org.au" />  
<input name="gate" type="hidden" value="SCNet_Cert6" />  
<input name="items" type="hidden" value="Donation - The Dogs' Refuge Home. Thank you for 
your gift. All donations $2.00 and over are tax deductible. Please retain this receipt." 
/>  
<input name="process" type="hidden" value="PROCESS" />  
<input name="shop" type="hidden" value="Donation - The Dogs' Refuge Home W.A. Inc. (ABN 
38564984197)" />  
<input name="message" type="hidden" value="Many thanks from The Dogs' Refuge Home." /> 
<input name="returl" type="hidden" value="http://www.dogshome.org.au/thanks-for-your-
donation/" />  
<input name="sendemail" type="hidden" value="Y" /> 
<div class="formbutt"> 
<input class="action" name="Proceed" type="submit" value="Proceed to Secure Payment Site" 
/></div> 
</form> 